Abstract
Background
Changing legislation regarding antimicrobial consumption (AMC) forces Flemish bovine veterinary practitioners (BVP) to rethink their business models and shift their on‐farm practices from curative to preventive. However, little is known about their current practices and opinions regarding antibiotic stewardship, mastitis treatment and bacteriological culturing (BC) of milk samples, or how they envision their current and future roles on dairy farms.
Methods
An online questionnaire including 58 questions regarding demographics, udder health monitoring services (UHMS) and opinion on AMC, antimicrobial resistance (AMR) and BC of milk was distributed among BVP. Responses were categorised by age, sex and years in practice and statistically compared.
Results
Forty BVP completed the questionnaire. Although 37 BVP (92.5%) hold great value to their UHMS, we demonstrate room for improvement in the visit frequency and content. Younger and early career BVP tend to be more aware of AMC, AMR and BC of milk.
Limitations
Due to the limited participation rate, caution is required when extrapolating the findings of this study.
Conclusion
Ongoing education and support are needed to tackle challenges and boost BVP’ skills and motivation regarding UHMS and AMC in Flanders in order to achieve more evidence‐based and preventive practices regarding udder health.
INTRODUCTION
Excessive antimicrobial consumption (AMC) globally, and the consequential rise in antimicrobial resistance (AMR), pose significant threats to both human and animal health, making prudent use of antimicrobials widely advocated. 1 , 2 Antimicrobials such as fluoroquinolones and third‐ and fourth‐generation cephalosporines have been identified by the World Health Organization (WHO) as critically important for human health, limiting their use for veterinary purposes. 3 , 4
In response to the growing awareness and concerns, a knowledge centre for antibiotic use and resistance in animals (AMCRA) was established in Belgium in 2012. It promotes good practices and responsible use of antimicrobials in veterinary medicine by publishing guidelines and setting goals. 5 AMCRA produced a formulary guiding pathogen‐ and species‐specific antibiotic treatment choices, accounting for both animal and human health, aiming for responsible use of all antibiotics and a decrease in the use of critically important antibiotics. In this formulary, antibiotics are subdivided into first, second and third choice of product per pathogen or disease and per species based on existing scientific evidence. Additionally, each active ingredient is given a colour (yellow, orange and red) depending on the importance for human and veterinary health. Yellow active ingredients can be administered and dispensed in the absence of laboratory results. Orange active ingredients can be administered and dispensed when laboratory results are available, but an antimicrobial sensitivity test is not necessary, while red active ingredients (such as fluoroquinolones and cefquinome in cases of Gram‐negative infections) can only be used and dispensed when laboratory results and an antibiotic sensitivity test indicate that this active ingredient is the only viable option. For example, a product such as cefquinome (third‐generation cephalosporin, critically important) is a third choice, an orange active ingredient for intramammary treatment and a third choice, red active ingredient for systemic treatment of bovine mastitis. Next to formulating guidelines, AMCRA is, in close cooperation with the government, also involved in AMC monitoring and benchmarking of veterinarians as well as (dairy) farmers. Such benchmarking makes it possible to establish goal‐oriented strategies and implement effective follow‐up procedures for AMC.
Between 60% and 70% of AMC in adult dairy cattle on dairy farms relates to the prevention and treatment of mastitis, indicating optimised udder health management remains crucial in decreasing AMC. 6 In Belgium, both veterinarians and dairy producers are responsible for good antibiotic stewardship. Still, until full alignment of Belgian Law with European Regulation 2019/6 regarding veterinary medicines, farmers retain the ability to administer antibiotics without consulting a veterinarian. 7 , 8 Since 2010, producers are legally allowed to have an on‐farm medicine stock for a period of 2 months, including antibiotics, provided they have a signed contract with a herd veterinarian who made an ‘initial diagnosis’. The herd veterinarian is responsible for the herd health status, and must visit the farm six times a year (every 2 months) at the invitation of the producer, check and sign the on‐farm medicine register, and make an evaluation report every 4 months. 8 The competences of dairy producers—in contrast to those of veterinarians—to decide whether an animal is in need of antibiotic treatment are, however, subject to debate. 9
So far, Belgian (bovine) veterinarians can legally administer, prescribe and dispense veterinary drugs, making sales of veterinary medicines, including antibiotics, part of their revenues. European Regulation 2019/6 prohibits prophylactic use of antimicrobials in veterinary medicine and therefore poses a threat to that business model to some extent. Veterinarians, however, also have the moral responsibility of consulting and guiding producers in using and minimising AMC on‐farm and making informed decisions about antibiotic therapy (Article 33bis, Code of Conduct, edition 2024). Furthermore, as the herd veterinarians of livestock farms, they are responsible by law for recording and registering the prescribed and dispensed antibiotics on the farm. 10 In order to meet the extralegal requirements of the national quality assurance system for dairy farming (IKM), dairy producers also (should) record all antibiotic treatments. 11
However, little is known about (i) the extent to which dairy veterinarians in Flanders, Belgium, are adhering to good antibiotic stewardship; (ii) their opinion regarding the (changing) legislative, extralegal and deontological frameworks; and (iii) their opinions on their changing on‐farm roles. This study, therefore, aims to address these knowledge gaps by determining Flemish dairy veterinarians’ practices and opinions regarding antibiotic usage, mastitis treatment and bacteriological culture of milk and exploring how they perceive their (future) roles as dairy farm (udder) health advisors.
MATERIALS AND METHODS
Microsoft Forms (Microsoft 365, Microsoft) was used to construct an online questionnaire. The questionnaire was piloted before publication by five experts (academic and field experts in udder health and communication), after which adjustments were made. Several digital newsletters (M‐teamUGent, Flemish Animal Health Service, Rundveeloket, Koesensor, AMCRA, pharmaceutical companies), veterinary professional journals (VeDa, Dierenartsenwereld) and social media (Facebook) were used to distribute the questionnaire. The questionnaire was only available in Dutch because we specifically targeted bovine veterinary practitioners (BVP) active in Flanders (the Dutch‐speaking northern part of Belgium, comprising 40% of the Belgian surface area and 60% of the Belgian population), 12 with dairy producers among their clientele. Participating was possible from February 2022 until October 2022. Each BVP could participate once. An incentive (200€ value) to a randomly selected participant was announced.
The questionnaire consisted of 58 questions regarding demographics (n = 4), information regarding the organisation of the veterinary practice (n = 4), knowledge and implementation of practices regarding udder health monitoring services (UHMS) (n = 19), treatment of clinical mastitis (n = 7) and subclinical mastitis (n = 6), respectively, and opinion regarding AMC, AMR and bacteriological culture (BC) of milk (n = 18).
Descriptive and statistical analyses
All data were collected via Microsoft Forms (Microsoft) and exported to Microsoft Excel (Microsoft).
Cross‐tables were used to explore differences between younger (≤50 years old, n = 28) and older (>50 years old, n = 12), male (n = 30) and female (n = 10), and early career (≤10 years in practice, n = 18) and mid/late career (>10 years in practice, n = 22) respondents. Pearson's chi‐square tests and Fisher's exact tests (when counts in the cross‐tables were low) were calculated. A p‐value ≤0.05 was seen as significant, and p‐values between 0.05 and 0.1 were seen as indicative of tendencies.
Descriptive and statistical analyses were performed using SPSS Statistics 29.
RESULTS
Demographics
Forty BVP completed the questionnaire in an average 30 minutes (min = 9 minutes and max = 202 minutes). Of the respondents, 30 were male (75%), and 28 (70%) were under the age of 50 years. A higher proportion of women than men were younger than 50 years (n = 10 [100%] and n = 18 [60%]). Among all respondents, 10 (25%) and eight (80%) had less than 10 years of practice experience, respectively. Additionally, 16 (53.3%) of the male and two (20%) of the female respondents were in practice for 11–40 years.
The average number of dairy farmers in the client base per participating BVP was 30, ranging from nine to 100. Nineteen (47.5%) of the participants worked as the single BVP in their practice, while others had one BVP colleague (n = 6, 15%) or were part of a larger team of BVP (n = 15, 37.5%). All BVP worked in a practice that also included other clientele, next to dairy producers. Other animal species that were focused on included beef cattle (39 of all BVP, 97.5%), veal calves (n = 2, 5%), small ruminants (n = 38, 95%), pigs (n = 12, 30%), poultry (n = 1, 2.5%), horses (n = 25, 62.5%) and companion animals (n = 15, 37.5%).
Udder health monitoring services
Among the participants, 13 (32.5%) acknowledged abstaining from UHMS (not providing any of the services listed in Table 1) on any of the dairy farms within their clientele (Table 1).
TABLE 1.
Numbers, frequencies and p‐values regarding udder health advisory services among 27 Flemish BVP providing such services, stratified by age, sex and years of experience in practice.
| Age | Sex | Years in practice | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Total (n = 40) |
Young (n = 28) a |
Older (n = 12) b |
p‐value c |
Male (n = 30) |
Female (n = 10) |
p‐value c |
Early career (n = 18) d |
Mid/Late career (n = 22) e |
p‐value c | |
| Providing udder health monitoring services f | 27 (67.5%) | 23 (82.1%) | 4 (33.3%) | 0.008 | 20 (66.7%) | 7 (70%) | NS | 13 (72.2%) | 14 (63.6%) | NS |
| Charging for provided udder health monitoring services f | 15 (55.6%) | 13 (56.5%) | 2 (50%) | NS | 11 (55%) | 4 (57.1%) | NS | 9 (69.2%) | 6 (42.9%) | NS |
| Age | Sex | Years in practice | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Total (n = 27) |
Young (n = 23) a |
Older (n = 4) b |
p‐value c |
Male (n = 20) |
Female (n = 7) |
p‐value c |
Early career (n = 13) d |
Mid/Late career (n = 14) e |
p‐value c | |
| Topics discussed as part of udder health monitoring services g | ||||||||||
| Milk sampling technique | 21 (77.8%) | 19 (82.6%) | 2 (50%) | NS | 16 (80%) | 5 (71.4%) | NS | 10 (76.9%) | 11 (78.6%) | NS |
| Bacteriological culturing | 26 (96.3%) | 22 (95.7%) | 4 (100%) | NS | 19 (95%) | 7 (100%) | NS | 13 (100%) | 13 (92.9%) | NS |
| Milking technique | 16 (59.2%) | 15 (65.2%) | 1 (25%) | NS | 13 (65%) | 3 (42.9%) | NS | 10 (76.9%) | 6 (42.9%) | 0.072 |
| Following and optimising the milking process | 9 (33.3%) | 9 (39.1%) | 0 (0%) | NS | 7 (35%) | 2 (28.6%) | NS | 6 (46.1%) | 3 (21.4%) | NS |
| Bacteriological culturing of milk (analyses and discussion) | 19 (70.4%) | 17 (74%) | 2 (50%) | NS | 14 (70%) | 5 (71.4%) | NS | 9 (69.2%) | 10 (71.4%) | NS |
| Development of protocols for mastitis treatment | 13 (48.1%) | 12 (52.2%) | 1 (25%) | NS | 12 (60%) | 1 (14.3%) | 0.077 | 7 (53.8%) | 6 (42.9%) | NS |
| Development of protocols for mastitis prevention | 12 (44.4%) | 11 (47.8%) | 1 (25%) | NS | 11 (55%) | 1 (14.3%) | 0.091 | 8 (61.5%) | 4 (28.6%) | 0.085 |
| Discussion and adjustments of mastitis prevention and treatment protocols (on a regular basis) | 12 (44.4%) | 10 (43.5%) | 2 (50%) | NS | 9 (45%) | 3 (42.9%) | NS | 7 (53.8%) | 5 (35.7%) | NS |
| Heifer management | 14 (51.9%) | 10 (43.5%) | 4 (100%) | 0.098 | 12 (60%) | 2 (28.6%) | NS | 8 (61.5%) | 6 (42.9%) | NS |
| Dry cow management | 22 (81.5%) | 18 (78.3%) | 4 (100%) | NS | 19 (95%) | 3 (42.9%) | 0.009 | 9 (69.2%) | 13 (92.9%) | NS |
| Selective dry cow therapy | 12 (44.4%) | 10 (43.5%) | 2 (50%) | NS | 10 (50%) | 2 (28.6%) | NS | 4 (30.8%) | 8 (57.1%) | NS |
| Selective treatment of clinical mastitis | 8 (29.6%) | 8 (34.8%) | 0 (0%) | NS | 6 (30%) | 2 (28.6%) | NS | 4 (30.8%) | 4 (28.6%) | NS |
Abbreviations: BVP, bovine veterinary practitioners; NS, non‐significant.
Less than or equal to 50 years of age.
More than 50 years of age.
p‐values ≤0.05: significant; p‐values = 0.05–0.1: indicative of a tendency.
Less than or equal to 10 years of experience in practice.
More than 10 years of experience in practice.
Numbers based on the total of participating BVP.
Numbers based on the BVP providing udder health advisory services.
Of those engaging in UHMS (n = 27), 16 (59%) reported doing so on less than 20% of the farms, 10 (37%) on 20%–60%, and none on every dairy farm in their clientele. Significantly more young than older BVP actively provided UHMS (n = 23 [82.1%] and n = 4 [33.3%], respectively; p = 0.008; Table 1). Among the 27 respondents actively providing UHMS, the (large) majority indicated discussing results of BC of milk (n = 26, 96.3%), milk sampling technique (n = 21, 77.8%), and dry cow management (n = 21 [77.8%] with significantly more male than female BVP doing the latter [n = 19 {95%} and n = 3 {42.9%}; p = 0.009]) with (some of) the clients. Tendencies of more early career than mid/late‐career BVP optimizing the milking technique (n = 10 [76.9%) and n = 6 [42.9%]; p = 0.072), more male than female BVP developing protocols for mastitis treatment (n = 12 [60%] and n = 1 [14.3%]; p = 0.077), and more older than younger BVP helping with heifer management (n = 4 [100%] and n = 18 [78.3%]; p = 0.098) were noticed (Table 1). Additionally, more males than females (n = 11 [55%] and n = 1 [14.3%]; p = 0.091) and more early‐career than mid/late‐career BVP (n = 8 [61.5%] and n = 4 [28.6%]; p = 0.085) tended to develop protocols for mastitis prevention.
Strikingly, only 15 (55.6%) of the BVP providing UHMS consistently charged their clientele for providing such services, with no differences across age, sex, or years of experience (Table 1).
Opinions
Benchmarking
Thirty participants (75%) reported awareness of the existence of mandatory benchmarking of antibiotic prescription and dispensing, yet only 28 of them (93%) reported discussing the results with less than 20% of their dairy farmers. Strikingly, only 20 (50%) of all participants agreed with the statement that benchmarking is useful for the dairy sector.
AMC and AMR
Twenty‐four (60%) of all participants and a significantly higher proportion of the younger compared with the older BVP (n = 20 [71.4%] and n = 4 [33.3%]; p = 0.037) were convinced that the dairy sector can substantially contribute to reducing AMC (Table 2). Twenty‐eight of all BVP (70%; a significantly higher proportion of younger compared to older [n = 24 {85.7%} and n = 4 {33.3%}; p = 0.002], female compared to men [n = 10 {100%} and n = 18 {60%}; p = 0.019] and early‐career compared to mid/late‐career BVP [n = 17 {94.4%} and n = 11 {50%}; p = 0.002]) agreed that AMC is a pivotal factor for AMR (Table 3).
TABLE 2.
General opinion of responding Flemish BVP regarding bacteriological culture of milk, udder health advice services and continuing education.
| Age | Sex | Years in practice | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Total (n = 40) |
Young (n = 28) a |
Older (n = 12) b |
p‐value c |
Male (n = 30) |
Female (n = 10) |
p‐value c |
Early career (n = 18) d |
Mid/Late career (n = 22) e |
p‐value c | |
| Perception of in which cases of mastitis, bacteriological culturing of milk is important | ||||||||||
| Mild clinical mastitis | 23 (57.5%) | 20 (71.4%) | 3 (25%) | 0.006 | 16 (80%) | 7 (70%) | NS | 13 (72.2%) | 10 (45.5%) | 0.088 |
| Moderate clinical mastitis | 28 (70%) | 24 (85.7%) | 4 (33.3%) | 0.002 | 20 (66.7%) | 8 (80%) | NS | 16 (88.9%) | 12 (54.5%) | 0.018 |
| Severe clinical mastitis | 35 (87.5%) | 24 (85.7%) | 11 (91.7%) | NS | 27 (90%) | 8 (80%) | NS | 15 (83.3%) | 20 (90.9%) | NS |
| Clinical mastitis with treatment failure | 28 (70%) | 18 (64.3%) | 10 (83.3%) | NS | 20 (66.7%) | 8 (80%) | NS | 14 (77.8%) | 14 (63.6%) | NS |
| Recurrence of clinical mastitis | 34 (85%) | 25 (89.3%) | 9 (75%) | NS | 24 (80%) | 10 (100%) | NS | 17 (94.4%) | 17 (77.3%) | NS |
| Subclinical mastitis with one increase in somatic cell count | 10 (25%) | 7 (25%) | 3 (25%) | NS | 8 (26.7%) | 2 (20%) | NS | 5 (27.8%) | 5 (22.7%) | NS |
| Subclinical mastitis with two or three increases in somatic cell count | 33 (82.5%) | 26 (92.9%) | 7 (58.3%) | 0.017 | 24 (80%) | 9 (90%) | NS | 16 (88.9%) | 17 (77.3%) | NS |
| Subclinical mastitis with four or more increases in somatic cell count | 16 (40%) | 10 (35.7%) | 6 (50%) | NS | 12 (40%) | 4 (40%) | NS | 8 (44.4%) | 8 (36.4%) | NS |
| Percentage of dairy clientele convinced of the value of bacteriological culturing | ||||||||||
| >60% of the dairy farmers | 5 (12.5%) | 2 (7.1%) | 3 (25%) | NS | 5 (16.7%) | 0 (0%) | NS | 1 (5.6%) | 4 (18.9%) | NS |
| Milk testing in a milk laboratory for veterinary practice f | ||||||||||
| Somatic milk cell counting | 3 (23.1%) | 1 (10%) | 2 (66.7%) | NS | 3 (30%) | 0 (0%) | NS | 1 (16.7%) | 2 (28.6%) | NS |
| Limited BC of milk with rapid tests | 9 (69.2%) | 8 (80%) | 1 (33.3%) | NS | 6 (60%) | 3 (100%) | NS | 5 (83.3%) | 4 (57.1%) | NS |
| Extended BC of milk | 5 (38.5%) | 3 (30%) | 2 (66.7%) | NS | 5 (50%) | 0 (0%) | NS | 2 (33.3%) | 3 (42.9%) | NS |
| Antibiotic susceptibility testing | 1 (7.7%) | 1 (10%) | 0 (0%) | NS | 1 (10%) | 0 (0%) | NS | 1 (16.7%) | 0 (0%) | NS |
| Things needed to become (better) advisor of udder health | ||||||||||
| Financial support | 14 (35%) | 10 (35.7%) | 1 (8.3%) | NS | 11 (36.7%) | 3 (30%) | NS | 8 (44.4%) | 6 (27.3%) | NS |
| More time | 21 (52.5%) | 16 (57.1%) | 5 (41.7%) | NS | 15 (50%) | 6 (60%) | NS | 8 (44.4%) | 13 (59.1%) | NS |
| More interest/motivation of the farmer | 26 (65%) | 19 (67.9%) | 7 (58.3%) | NS | 21 (70%) | 5 (50%) | NS | 13 (72.2%) | 13 (59.1%) | NS |
| More training | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Better training | 10 (25%) | 9 (32.1%) | 1 (8.3%) | NS | 4 (13.3%) | 6 (60%) | 0.007 | 5 (27.8%) | 5 (22.7%) | NS |
| More tools | 10 (25%) | 10 (35.7%) | 0 (0%) | 0.019 | 8 (26.7%) | 2 (20%) | NS | 6 (33.3%) | 4 (18.9%) | NS |
| Better tools | 5 (12.5%) | 4 (14.3%) | 1 (8.3%) | NS | 3 (10%) | 2 (20%) | NS | 2 (11.1%) | 3 (13.6%) | NS |
| More support from colleagues in the practice | 7 (17.5%) | 6 (21.4%) | 1 (8.3%) | NS | 4 (13.3%) | 3 (30%) | NS | 5 (27.8%) | 2 (10.1%) | NS |
| Attendance frequency of continuing education per year | ||||||||||
| <5 per year | 4 (10%) | 3 (10.7%) | 1 (8.3%) | NS | 3 (10%) | 1 (10%) | NS | 3 (16.7%) | 1 (4.5%) | NS |
| 5–10 per year | 24 (60%) | 16 (57.1%) | 8 (66.7%) | NS | 17 (56.7%) | 7 (70%) | NS | 10 (55.6%) | 14 (63.6%) | NS |
| >10 per year | 12 (30%) | 10 (35.7%) | 2 (16.7%) | NS | 10 (33.3%) | 2 (20%) | NS | 5 (27.8%) | 7 (31.8%) | NS |
| Most frequent veterinary medicine information sources | ||||||||||
| Literature | 25 (62.5%) | 18 (64.3%) | 7 (58.3%) | NS | 20 (66.7%) | 5 (50%) | NS | 12 (66.7%) | 13 (59.1%) | NS |
| Paid training | 23 (57.5%) | 18 (64.3%) | 5 (41.7%) | NS | 15 (50%) | 8 (80%) | NS | 11 (61.1%) | 12 (54.5%) | NS |
| Free training | 35 (87.5%) | 25 (89.3%) | 10 (83.3%) | NS | 26 (86.7%) | 9 (90%) | NS | 15 (83.3%) | 20 (90.9%) | NS |
| National congresses | 7 (17.5%) | 5 (17.9%) | 2 (16.7%) | NS | 6 (20%) | 1 (10%) | NS | 3 (16.7%) | 4 (18.9%) | NS |
| International congresses | 9 (22.5%) | 6 (21.4%) | 3 (25%) | NS | 8 (26.7%) | 1 (10%) | NS | 4 (22.2%) | 5 (22.7%) | NS |
| Contact with colleagues | 20 (50%) | 18 (64.3%) | 2 (16.7%) | 0.006 | 13 (43.3%) | 7 (70%) | NS | 14 (77.8%) | 6 (27.3%) | 0.001 |
| Contact with pharmaceutical representatives | 20 (50%) | 16 (57.1%) | 4 (33.3%) | NS | 18 (60%) | 2 (20%) | 0.028 | 10 (55.6%) | 10 (45.5%) | NS |
| Free webinars | 28 (70%) | 20 (71.4%) | 8 (66.7%) | NS | 22 (73.3%) | 6 (60%) | NS | 10 (55.6%) | 18 (81.8%) | 0.071 |
| Paid webinars | 13 (32.5%) | 12 (42.9%) | 1 (8.3%) | 0.063 | 8 (26.7%) | 5 (50%) | NS | 5 (27.8%) | 8 (36.4%) | NS |
| Social media and the internet | 1 (2.5%) | 1 (3.6%) | 0 (0%) | NS | 1 (3.3%) | 0 (0%) | NS | 1 (5.6%) | 0 (0%) | NS |
| Newsletters | 19 (47.5%) | 15 (53.6%) | 4 (33.3%) | NS | 17 (56.7%) | 2 (20%) | 0.069 | 6 (33.3%) | 13 (59.1%) | NS |
Abbreviations: BC, bacteriological culturing; BVP, bovine veterinary practitioners; NS, non‐significant.
Less than or equal to 50 years of age.
More than 50 years of age.
p‐values ≤0.05: significant.
Less than or equal to 10 years of experience in practice.
More than 10 years of experience in practice.
Numbers based on the BVP that have a milk laboratory on practice (total: n = 13; young = 10, older = 3, male = 10, female = 3, early career = 6, mid/late career = 7).
TABLE 3.
Numbers, frequencies and p‐values regarding adherence to AMCRA guidelines, antimicrobial usage and opinions among responding Flemish BVP, stratified by age, sex and years of experience in practice.
| Age | Sex | Years in practice | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Total (n = 40) |
Young (n = 28) a |
Older (n = 12) b |
p‐value c |
Male (n = 30) |
Female (n = 10) |
p‐value c |
Early career (n = 18) d |
Mid/Late career (n = 22) e |
p‐value c | |
| Following AMCRA guidelines regarding first, second and third choice of antibiotics | ||||||||||
| When using antibiotics for clinical mastitis | 23 (57.5%) | 18 (64.3%) | 5 (41.7%) | NS | 17 (57%) | 6 (60%) | NS | 12 (66.7%) | 11 (50%) | NS |
| When using antibiotics for subclinical mastitis | 24 (60%) | 20 (71.4%) | 4 (33.3%) | 0.005 | 20 (66.7%) | 4 (40%) | NS | 13 (72.2%) | 11 (50%) | NS |
| When dispensing antibiotics for clinical mastitis | 27 (67.5%) | 21 (75%) | 6 (50%) | NS | 19 (63.3%) | 8 (80%) | NS | 14 (77.8%) | 13 (59.1%) | NS |
| When dispensing antibiotics for subclinical mastitis | 28 (70%) | 23 (82.1%) | 5 (41.7%) | NS | 20 (66.7%) | 8 (80%) | NS | 15 (83.3%) | 13 (59.1%) | 0.096 |
| Antimicrobial usage | ||||||||||
| Never making use of critically important antibiotics f | 12 (30%) | 10 (35.7%) | 2 (16.7%) | NS | 10 (33.3%) | 2 (20%) | NS | 4 (22.2%) | 8 (36.4%) | NS |
| Never treating mastitis with antibiotics | 21 (52.5%) | 17 (60.7%) | 4 (33.3%) | NS | 16 (53.3%) | 5 (50%) | NS | 10 (55.6%) | 11 (50%) | NS |
| Opinions | ||||||||||
| Benchmarking AMC is useful for the dairy sector | 20 (50%) | 16 (57.1%) | 4 (33.3%) | NS | 14 (46.7%) | 6 (60%) | NS | 9 (69.2%) | 11 (50%) | NS |
| Dairy sector can substantially contribute to reducing AMC | 24 (60%) | 20 (71.4%) | 4 (33.3%) | 0.037 | 18 (60%) | 6 (60%) | NS | 13 (72.2%) | 11 (50%) | NS |
| AMC is an important factor related to AMR | 28 (70%) | 24 (85.7%) | 4 (33.3%) | 0.002 | 18 (60%) | 10 (100%) | 0.019 | 17 (94.4%) | 11 (50%) | 0.002 |
| Veterinarians play an important role in on‐farm AMC | 37 (92.5%) | 26 (92.9%) | 11 (91.7%) | NS | 28 (93.3%) | 9 (90%) | NS | 17 (94.4%) | 20 (90.9%) | NS |
| Contributing to reducing AMC is important | 34 (85%) | 25 (89.3%) | 9 (75%) | NS | 25 (83.3%) | 9 (90%) | NS | 16 (88.9%) | 18 (81.8%) | NS |
| Bacteriological culturing is important in the context of mastitis | 38 (95%) | 28 (100%) | 10 (83.3%) | 0.085 | 28 (93.3%) | 10 (100%) | NS | 18 (100%) | 20 (90.9%) | NS |
| Aware of the existence of rapid tests for bacteriological culture of milk | 24 (60%) | 22 (78.6%) | 2 (16.7%) | <0.001 | 16 (53.3%) | 8 (80%) | NS | 14 (77.8%) | 10 (45.5%) | 0.038 |
| Running a milk laboratory in the veterinary practice | 13 (32.5%) | 10 (35.7%) | 3 (25%) | NS | 10 (33.3%) | 3 (30%) | NS | 6 (33.3%) | 7 (31.8%) | NS |
| Role of veterinarian as a herd health advisor is important | 37 (92.5%) | 27 (96.4%) | 10 (83.3%) | NS | 27 (90%) | 10 (100%) | NS | 18 (100%) | 19 (86.4%) | NS |
Abbreviations: AMC, antimicrobial consumption; AMCRA, Belgian knowledge centre for antibiotic use and resistance in animals; AMR, antimicrobial reduction; BC, bacteriological culturing; BVP, bovine veterinary practitioners; NS, non‐significant.
Less than or equal to 50 years of age.
More than 50 years of age.
p‐values ≤0.05: significant.
Less than or equal to 10 years of experience in practice.
More than 10 years of experience in practice.
Antibiotics such as fluoroquinolones and third‐ and fourth‐generation cephalosporines, identified by the WHO as critically important for human health.
Bacteriological culturing of milk
Thirty‐eight of all participants (95%; more young [n = 28, 100%] than older BVP [n = 10, 83.3%]; p = 0.085) recognised the substantial value of BC of milk in the context of mastitis (Table 3). Participants identified BC of milk most as particularly beneficial in cases of severe clinical mastitis (n = 35, 87.5% of all BVP), recurrence of clinical mastitis (n = 34, 85%), subclinical mastitis with a second or third elevated SCC in a row (n = 33, 82.5%; significantly more young [n = 26, 92.9%] than older [n = 7, 58.3%; p = 0.017] BVP), moderate clinical mastitis (n = 28, 70%; significantly more young [n = 24, 85.7%] than older [n = 4, 33.3%; p = 0.002] and early‐career [n = 16, 88.9%] than mid/late‐career [n = 12, 54.5%; p = 0.018] BVP), in cases of lack of response to treatment (n = 28, 70%), and in mild cases of clinical mastitis (n = 23, 57.5%; significantly more young [n = 20, 71.4%] than older [n = 3, 25%; p = 0.006] BVP) (Table 2). Despite being convinced of the importance of BC, only five (12.5%) of the BVP were able to convince more than 60% of their clientele of it (Table 2). Twenty‐four participants (60%; significantly more younger than older [n = 22 {78.6%} and n = 2 {16.7%}; p < 0.001] and early‐career than mid/late‐career BVP [n = 14 {77.8%} and n = 10 {45.5%}; p = 0.038]) reported awareness of the existence of rapid tests for BC of milk, whereas 13 (32.5%) ran a milk laboratory in their practice (Table 3), primarily used for conducting BC of milk (n = 9 [69.2%] and n = 5 [38.5%], respectively) (Table 2). Insufficient knowledge regarding BC of milk (10 of all BVP, 37%) and time constraints for analyzing milk samples (n = 9, 33.3%), reluctance to make the necessary investment (n = 7, 25.9%), lack of interest from the dairy clientele (n = 6, 22.2%), not seeing the point of self‐executing BC of milk (n = 6, 22.2%), and overall lack of interest in performing BC in their practice (n = 2, 7.4%) were reasons to not establish such (basic) milk laboratory.
Perception of their role as udder health advisors
Thirty‐seven of the respondents (92.5%) considered their on‐farm advisory role regarding UHMS to be important (Table 3). More motivation/interest from the dairy producer (n = 25, 62.5%) and more time (n = 21, 52.5%) were some of the experienced shortages to become a better herd health advisor (Table 2). Additionally, significantly more female than male BVP (n = 6 [60%] and n = 4 [13.3%]; p = 0.007) indicated a need for better training, while more younger than older BVP wanted more tools to elevate their UHMS skills (n = 10 [35.7%] and n = 0 [0%]; p = 0.019) (Table 2). Significantly more younger than older (n = 18 [64.3%] and n = 2 [16.7%]; p = 0.006) and more early‐career than mid/late‐career BVP (n = 14 [77.8%] and n = 6 [27.3%]; p = 0.001) preferred contact with colleagues as a veterinary information source (Table 2). Also, significantly more male than female BVP (n = 18 [60%] and n = 2 [20%]; p = 0.028) preferred contact with pharmaceutical representatives, and more male than female (n = 17 [56.7%] and n = 2 [20%]; p = 0.069) tended to get information from newsletters (Table 2). Mid/Late‐career BVP tended to follow free webinars more than early‐career vets (n = 18 [81.8%] and n = 10 [55.6%]; p = 0.071). Younger BVP indicated following more paid webinars than older BVP (n = 12 [42.9%] and n = 1 [8.3%]; p = 0.063) (Table 2).
Mastitis treatment
Twenty‐three (57.5%) and 24 (60%) of the 40 responding veterinarians indicated that they frequently follow the guidelines regarding first, second or third choice products outlined by AMCRA when administering antibiotics to treat clinical and subclinical mastitis, respectively. Significantly more young than older BVP are doing so in the latter case (n = 20 [71.4%] and n = 4 [33.3%]; p = 0.005; Table 3). Additionally, when antibiotics were dispensed, 27 (67.5%) and 28 (70%) of all BVP indicated to adhere to these guidelines for clinical and subclinical mastitis, respectively, with a tendency of more early‐career than mid/late‐career BVP doing so for subclinical mastitis (n = 15 [83.3%] and n = 13 [59.1%]; p = 0.096) (Table 3). Treating with critically important antibiotics was based on the herd's mastitis history (n = 17, 42.5%), the severity of the mastitis case (n = 13, 32.5%), the results of BC with antibiogram (n = 8, 20%) and the dairy producer (n = 7, 17.5%). Only 12 of all BVP (30%) stated to strictly avoid such antibiotics for mastitis treatments, with no differences between sex, age or experience (Table 3).
Reasons for not treating cases of mastitis or treating without antibiotics (any other treatment options not specified), given by 21 (52.5%) of the respondents (Table 3), included chronic cases of clinical mastitis (17 of all BVP, 33.3%), suspected intramammary infections with yeasts or fungi (n = 14, 66.7%), mild (n = 11, 52.4%) or moderate (n = 1, 4.8%) clinical mastitis cases, and suspected infections with Gram‐negative bacteria (n = 6, 28.6%).
Clinical mastitis
Thirteen of all the respondents (32.5%; significantly more older than younger BVP [n = 7 {58.3%} and n = 6 {21.4%}; p = 0.032; Table 4) indicated a treatment duration of 5 days as ideal, with no difference between strata. The combination of antibiotics and prednisolone (available as a lactating tube on the Belgian market) was the most commonly administered antibiotic for intramammary treatment of clinical mastitis (n = 18, [45%], significantly more by younger than by older BVP [n = 17 {60.7%} and n = 1 {8.3%}; p = 0.002]). Other frequently administered antibiotics were combinations including aminoglycosides (n = 11, 27.5%; in Belgium only available in combination with cefalexin or penicillin), first generation cephalosporins (n = 11, 27.5%) and fourth generation cephalosporins (n = 11 [27.5%], more so by older than by younger BVP [n = 6 {50%} and n = 5 {17.9%}; p = 0.056]). Other preferences are presented in Table 4.
TABLE 4.
Numbers, frequencies and p‐values regarding treatment duration, used and dispensed products for milk sample collection for bacteriological culture of clinical mastitis cases among responding Flemish BVP, stratified by age, sex and years of experience in practice.
| Age | Sex | Years in practice | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Total (n = 40) |
Young (n = 28) a |
Older (n = 12) b |
p‐value c |
Male (n = 30) |
Female (n = 10) |
p‐value c |
Early career (n = 18) d |
Mid/Late career (n = 22) e |
p‐value c | |
| Ideal treatment duration for clinical mastitis | ||||||||||
| <3 days | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| 3 days | 6 (15%) | 4 (14.3%) | 2 (16.7%) | NS | 5 (16.7%) | 1 (10%) | NS | 2 (11.1%) | 4 (18.2%) | NS |
| 4 days | 2 (5%) | 2 (7.1%) | 0 (0%) | NS | 2 (6.7%) | 0 (0%) | NS | 1 (5.6%) | 1 (5%) | NS |
| 5 days | 13 (32.5%) | 6 (21.4%) | 7 (58.3%) | 0.032 | 9 (30%) | 4 (40%) | NS | 6 (33.3%) | 7 (31.8%) | NS |
| Until milk appearance is normal | 7 (17.5%) | 6 (21.4%) | 1 (8.3%) | NS | 6 (20%) | 1 (10%) | NS | 4 (22.2%) | 3 (13.6%) | NS |
| Until the cow is free of clinical symptoms | 9 (22.5%) | 8 (28.6%) | 1 (8.3%) | NS | 7 (23.3%) | 2 (20%) | NS | 5 (27.8%) | 4 (18.2%) | NS |
| Depends on the pathogen | 3 (7.5%) | 2 (7.1%) | 1 (8.3%) | NS | 1 (3.3%) | 2 (20%) | NS | 0 (0%) | 3 (13.6%) | NS |
| Compounds administered for intramammary treatment of clinical mastitis | ||||||||||
| Combination of antibiotics with prednisolone f | 18 (45%) | 17 (60.7%) | 1 (8.3%) | 0.002 | 14 (46.7%) | 4 (40%) | NS | 11 (61.1%) | 7 (31.8%) | 0.064 |
| Penicillin | 4 (10%) | 3 (10.7%) | 1 (8.3%) | NS | 3 (10%) | 1 (10%) | NS | 3 (16.7%) | 1 (5%) | NS |
| Cloxacillin | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Ampicillin | 3 (7.5%) | 1 (3.8%) | 2 (16.7%) | NS | 2 (6.7%) | 1 (10%) | NS | 1 (5.6%) | 2 (1%) | NS |
| First‐generation cephalosporins | 11 (27.5%) | 8 (28.6%) | 3 (25%) | NS | 7 (23.3%) | 4 (40%) | NS | 6 (33.3%) | 5 (22.7%) | NS |
| Fourth‐generation cephalosporins | 11 (27.5%) | 5 (17.9%) | 6 (50%) | 0.056 | 10 (33.3%) | 1 (10%) | NS | 3 (16.7%) | 8 (36.4%) | NS |
| Aminoglycosides f | 11 (27.5%) | 7 (25%) | 4 (33.3%) | NS | 10 (33.3%) | 1 (10%) | NS | 5 (27.8%) | 6 (27.3%) | NS |
| Self‐composed udder infusion | 9 (22.5%) | 6 (21.4%) | 3 (25%) | NS | 7 (23.3%) | 2 (20%) | NS | 4 (22.2%) | 5 (22.7%) | NS |
| Compounds dispensed for intramammary treatment of clinical mastitis | ||||||||||
| Combination of antibiotics with prednisolone f | 12 (30%) | 12 (42.9%) | 0 (0%) | 0.007 | 10 (33.3%) | 2 (20%) | NS | 7 (38.9%) | 5 (22.7%) | NS |
| Penicillin | 10 (25%) | 7 (25%) | 3 (25%) | NS | 6 (20%) | 4 (40%) | NS | 6 (33.3%) | 4 (18.2%) | NS |
| Cloxacillin | 4 (10%) | 4 (14.3%) | 0 (0%) | NS | 4 (13.3%) | 0 (0%) | NS | 1 (5.6%) | 3 (13.6%) | NS |
| Ampicillin | 8 (20%) | 5 (17.9%) | 3 (25%) | NS | 7 (23.3%) | 1 (10%) | NS | 2 (11.1%) | 6 (27.3%) | NS |
| First‐generation cephalosporins | 16 (40%) | 11 (39.3%) | 5 (41.7%) | NS | 10 (33.3%) | 6 (60%) | NS | 7 (38.9%) | 9 (40.9%) | NS |
| Fourth‐generation cephalosporins | 14 (35%) | 7 (25%) | 7 (58.3%) | 0.071 | 13 (43.3%) | 1 (10%) | 0.070 | 4 (22.2%) | 10 (45.5%) | NS |
| Aminoglycosides g | 20 (50%) | 17 (60.7%) | 3 (25%) | 0.038 | 15 (50%) | 5 (50%) | NS | 10 (55.6%) | 10 (45.5%) | NS |
| Self‐composed udder infusion h | 1 (2.5%) | 1 (3.8%) | 0 (0%) | NS | 0 (0%) | 1 (10%) | NS | 1 (5.6%) | 0 (0%) | NS |
| Compounds administered for systemic treatment of clinical mastitis | ||||||||||
| Non‐steroidal anti‐inflammatory drugs | 39 (97.5%) | 27 (96.4%) | 12 (100%) | NS | 30 (100%) | 9 (90%) | NS | 17 (94.4%) | 22 (100%) | NS |
| Corticosteroids | 20 (50%) | 13 (46.4%) | 7 (58.3%) | NS | 13 (43.3%) | 7 (70%) | NS | 7 (38.9%) | 13 (59.1%) | NS |
| Penicillin | 19 (47.5%) | 15 (53.6%) | 4 (33.3%) | NS | 13 (43.3%) | 6 (60%) | NS | 11 (61.1%) | 8 (36.4%) | NS |
| First‐generation cephalosporins | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Fourth‐generation cephalosporins | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Macrolides | 14 (35%) | 10 (35.7%) | 4 (33.3%) | NS | 9 (30%) | 5 (50%) | NS | 9 (50%) | 5 (22.7%) | 0.072 |
| Fluoroquinolones | 3 (7.5%) | 2 (7.1%) | 1 (8.3%) | NS | 3 (10%) | 0 (0%) | NS | 1 (5.6%) | 2 (1%) | NS |
| Aminoglycosides | 5 (12.5%) | 2 (7.1%) | 3 (25%) | NS | 5 (16.7%) | 0 (0%) | NS | 1 (5.6%) | 4 (18.2%) | NS |
| Sulfonamide‐trimethoprim | 33 (82.5%) | 26 (92.9%) | 7 (58.3%) | 0.017 | 25 (83.3%) | 8 (80%) | NS | 16 (88.9%) | 17 (77.3%) | NS |
| None | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Compounds dispensed for systemic treatment of clinical mastitis | ||||||||||
| Non‐steroidal anti‐inflammatory drugs | 33 (82.5%) | 24 (85.7%) | 9 (75%) | NS | 25 (83.3%) | 8 (80%) | NS | 15 (83.3%) | 18 (81.8%) | NS |
| Corticosteroids | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Penicillin | 27 (67.5%) | 19 (67.9%) | 8 (66.7%) | NS | 21 (70%) | 6 (60%) | NS | 11 (61.1%) | 16 (72.7%) | NS |
| First‐generation cephalosporins | 1 (2.5%) | 1 (3.8%) | 0 (0%) | NS | 0 (0%) | 1 (10%) | NS | 1 (5.6%) | 0 (0%) | NS |
| Fourth‐generation cephalosporins | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Macrolides | 15 (37.5%) | 10 (35.7%) | 5 (41.7%) | NS | 9 (30%) | 6 (60%) | NS | 8 (44.4%) | 17 (77.3%) | NS |
| Fluoroquinolones | 1 (2.5%) | 1 (3.8%) | 0 (0%) | NS | 1 (3.3%) | 0 (0%) | NS | 1 (5.6%) | 0 (0%) | NS |
| Aminoglycosides | 5 (12.5%) | 2 (7.1%) | 3 (25%) | NS | 5 (16.7%) | 0 (0%) | NS | 1 (5.6%) | 4 (18.2%) | NS |
| Sulfonamide‐trimethoprim | 27 (67.5%) | 21 (75%) | 6 (50%) | NS | 21 (70%) | 6 (60%) | NS | 13 (72.2%) | 14 (63.6%) | NS |
| None | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Frequency of routinely collecting milk samples for bacteriological culture | ||||||||||
| On <20% of the dairy farms | 21 (52,5%) | 13 (56.4%) | 8 (66.7%) | NS | 16 (53.3%) | 5 (50%) | NS | 7 (38.9%) | 14 (63.6%) | NS |
| On 20%–40% of the dairy farms | 11 (27.5%) | 10 (35.7%) | 1 (8.3%) | NS | 7 (23.3%) | 4 (40%) | NS | 6 (33.3%) | 5 (22.7%) | NS |
| On ≥41% of the dairy farms | 8 (20%) | 5 (17.9%) | 3 (25%) | NS | 7 (23.3%) | 1 (10%) | NS | 5 (27.8%) | 3 (13.6%) | NS |
Abbreviations: BVP, bovine veterinary practitioners; NS, non‐significant.
Less than or equal to 50 years of age.
More than 50 years of age.
p‐values ≤0.05: significant.
Less than or equal to 10 years of experience in practice.
More than 10 years of experience in practice.
Synulox (Zoetis): amoxicillin, clavulanic acid and prednisolone or Mastiplan (Intervet): cephapirin and prednisolone.
Ubrolexin (Boehringer Ingelheim): kanamycin and cefalexin or MASTI‐kel (Kela): procain benzylpenicillin and neomycin.
An off‐label cow‐side self‐made mixture of antimicrobials and other drugs.
Aminoglycosides were the most popular compounds to be dispensed for the intramammary treatment of clinical mastitis (n = 20 [50%], significantly more by younger than by older BVP [n = 17 {60.7%} and n = 3 {25%}; p = 0.038]). Also, the combination of antibiotics with prednisolone was significantly more popular to dispense for intramammary treatment among younger than older BVP (n = 12 [72.9%] and n = 0 [0%]; p = 0.007). More older than younger (n = 7 [58.3%] and n = 7 [25%]; p = 0.071) and male than female BVP (n = 13 [43.3%] and n = 1 [10%]; p = 0.070) tended to dispense fourth‐generation cephalosporines. Other administered and dispensed compounds are presented in Table 4. NSAIDs were most frequently used (n = 39, 97.5%) and dispensed (n = 33, 82.5%) for the systemic supportive treatment of clinical mastitis (Table 4). Additionally, significantly more younger than older BVP used sulfonamide‐trimethoprim (n = 26 [92.9%] and n = 7 [58.3%]; p = 0.017), and more early‐career than mid/late‐career BVP tended to use macrolides (n = 9 [50%] and n = 5 [22.7%]; p = 0.072) (Table 4).
Only a minority of the participants (n = 8, 20%) routinely collected milk samples from clinical mastitis cases for BC on 41%–80% of the farms in their clientele, while 21 (52.5%) reported doing so on less than 20% of the farms in their clientele, with no differences between age, sex and years of experience (Table 4).
Subclinical mastitis
A treatment duration of either 3 days (n = 16, 40%) or 5 days (n = 15 [37.5%], more by male than female BVP [n = 14 {46.7%} and n = 1 {10%}; p = 0.060]) was preferred by the participants to tackle subclinical mastitis. Significantly more female than male BVP continued treatment of subclinical mastitis cases until the somatic cell count (SCC) returned to a normal value (n = 3 [30%] and n = 1 [3.3%]; p = 0.042) (Table 5). Fourth‐generation cephalosporines were significantly more dispensed by older than younger (n = 6 [50%] and n = 4 [14.3%]; p = 0.041) and male than female BVP (n = 10 [33.3%] and n = 0 [0%]; p = 0.043) (Table 5). As for the systemic treatment, NSAIDs were significantly more used by younger than older BVP (n = 13 [46.4%] and n = 1 [8.3%]; p = 0.030), while also early‐career BVP tended to use these products more than mid/late‐career BVP (n = 9 [50%] and n = 5 [22.7%]; p = 0.072). Additionally, more early‐career than mid/late‐career BVP tended to administer macrolides for systemic therapy (n = 8 [44.4%] and n = 4 [18.2%]; p = 0.071) (Table 5).
TABLE 5.
Numbers, frequencies and p‐values regarding treatment duration, used and dispensed products for milk sample collection for bacteriological culture of subclinical mastitis cases among responding Flemish BVP, stratified by age, sex and years of experience in practice.
| Age | Sex | Years in practice | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Total (n = 40) |
Young (n = 28) a |
Older (n = 12) b |
p‐value c |
Male (n = 30) |
Female (n = 10) |
p‐value c |
Early career (n = 18) d |
Mid/Late career (n = 22) e |
p‐value c | |
| Ideal treatment duration for subclinical mastitis | ||||||||||
| <3 days | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| 3 days | 16 (40%) | 12 (42.9%) | 4 (33.3%) | NS | 12 (40%) | 4 (40%) | NS | 7 (38.9%) | 9 (40.9%) | NS |
| 4 days | 2 (5%) | 1 (3.8%) | 1 (8.3%) | NS | 2 (6.7%) | 0 (0%) | NS | 1 (5.6%) | 1 (5%) | NS |
| 5 days | 15 (37.5%) | 9 (32.1%) | 6 (50%) | NS | 14 (46.7%) | 1 (10%) | 0.060 | 6 (33.3%) | 9 (40.9%) | NS |
| Until somatic cell count is normal | 4 (10%) | 4 (14.3%) | 0 (0%) | NS | 1 (3.3%) | 3 (30%) | 0.042 | 3 (16.7%) | 1 (5%) | NS |
| Until California Mastitis Test is normal | 1 (2.5%) | 1 (3.8%) | 0 (0%) | NS | 0 (0%) | 1 (10%) | NS | 1 (5.6%) | 0 (0%) | NS |
| Other | 2 (5%) | 1 (3.8%) | 1 (8.3%) | NS | 1 (3.3%) | 1 (10%) | NS | 0 (0%) | 2 (9%) | NS |
| Compounds dispensed for intramammary treatment of subclinical mastitis | ||||||||||
| Combination of antibiotics with prednisolone f | 2 (5%) | 1 (3.8%) | 1 (8.3%) | NS | 2 (6.7%) | 0 (0%) | NS | 0 (0%) | 2 (9%) | NS |
| Penicillin | 21 (52.5%) | 15 (53.8%) | 6 (50%) | NS | 17 (56.7%) | 4 (40%) | NS | 8 (44.4%) | 13 (59.1%) | NS |
| Cloxacillin | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Ampicillin | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| First‐generation cephalosporins | 15 (37.5%) | 12 (42.9%) | 3 (25%) | NS | 9 (30%) | 6 (60%) | NS | 8 (44.4%) | 7 (31.8%) | NS |
| Fourth‐generation cephalosporins | 10 (25%) | 4 (14.3%) | 6 (50%) | 0.041 | 10 (33.3%) | 0 (0%) | 0.043 | 2 (11.1%) | 8 (36.4%) | 0.082 |
| Aminoglycosides g | 13 (32.5%) | 11 (39.3%) | 2 (16.7%) | NS | 11 (36.7%) | 2 (20%) | NS | 5 (27.8%) | 8 (36.4%) | NS |
| Self‐composed udder infusion h | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| None | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Compounds administered for systemic treatment of subclinical mastitis | ||||||||||
| Non‐steroidal anti‐inflammatory drugs | 14 (35%) | 13 (46.4%) | 1 (8.3%) | 0.030 | 12 (40%) | 2 (20%) | NS | 9 (50%) | 5 (22.7%) | 0.072 |
| Corticosteroids | 2 (5%) | 1 (3.8%) | 1 (8.3%) | NS | 2 (6.7%) | 0 (0%) | NS | 1 (5.6%) | 1 (5%) | NS |
| Penicillin | 20 (50%) | 14 (50%) | 6 (50%) | NS | 16 (53.3%) | 4 (40%) | NS | 11 (61.1%) | 9 (40.9%) | NS |
| First‐generation cephalosporins | 3 (7.5%) | 2 (7.1%) | 1 (8.3%) | NS | 2 (6.7%) | 1 (10%) | NS | 2 (11.1%) | 1 (5%) | NS |
| Fourth‐generation cephalosporins | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Macrolides | 12 (30%) | 9 (32.1%) | 3 (25%) | NS | 9 (30%) | 3 (30%) | NS | 8 (44.4%) | 4 (18.2%) | 0.071 |
| Fluoroquinolones | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Aminoglycosides | 5 (12.5%) | 2 (7.1%) | 3 (25%) | NS | 5 (16.7%) | 0 (0%) | NS | 1 (5.6%) | 4 (18.2%) | NS |
| Sulfonamide‐trimethoprim | 12 (30%) | 9 (32.1%) | 3 (25%) | NS | 10 (33.3%) | 2 (20%) | NS | 7 (38.9%) | 5 (22.7%) | NS |
| None | 9 (22.5%) | 7 (25%) | 2 (16.7%) | NS | 6 (20%) | 3 (30%) | NS | 2 (11.1%) | 7 (31.8%) | NS |
| Compounds dispensed for systemic treatment of subclinical mastitis | ||||||||||
| Non‐steroidal anti‐inflammatory drugs | 11 (27.5%) | 10 (35.7%) | 1 (8.3%) | NS | 8 (26.7%) | 3 (30%) | NS | 6 (33.3%) | 5 (22.7%) | NS |
| Corticosteroids | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Penicillin | 24 (60%) | 18 (64.3%) | 6 (50%) | NS | 18 (60%) | 6 (60%) | NS | 11 (61.1%) | 13 (59.1%) | NS |
| First‐generation cephalosporins | 4 (10%) | 4 (14.3%) | 0 (0%) | NS | 2 (6.7%) | 2 (20%) | NS | 3 (16.7%) | 1 (5%) | NS |
| Fourth‐generation cephalosporins | 1 (2.5%) | 0 (0%) | 1 (8.3%) | NS | 1 (3.3%) | 0 (0%) | NS | 0 (0%) | 1 (5%) | NS |
| Macrolides | 16 (40%) | 12 (30%) | 4 (33.3%) | NS | 10 (33.3%) | 6 (60%) | NS | 9 (50%) | 7 (31.8%) | NS |
| Fluoroquinolones | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Aminoglycosides | 7 (17.5%) | 4 (14.3%) | 3 (25%) | NS | 7 (23.3%) | 0 (0%) | NS | 2 (11.1%) | 5 (22.7%) | NS |
| Sulfonamide‐trimethoprim | 10 (25%) | 9 (22.5%) | 1 (8.3%) | NS | 9 (30%) | 1 (10%) | NS | 6 (33.3%) | 4 (18.2%) | NS |
| None | 3 (7.5%) | 2 (7.1%) | 1 (8.3%) | NS | 2 (6.7%) | 1 (10%) | NS | 2 (11.1%) | 1 (5%) | NS |
| Frequency of routinely collecting milk samples for bacteriological culturing | ||||||||||
| On <20% of the dairy farms | 26 (65%) | 17 (60.7%) | 9 (75%) | NS | 17 (56.7%) | 9 (90%) | 0.070 | 12 (66.7%) | 14 (63.6%) | NS |
| On 20%–40% of the dairy farms | 12 (30%) | 10 (35.7%) | 2 (16.7%) | NS | 11 (36.7%) | 1 (10%) | NS | 6 (33.3%) | 6 (27.3%) | NS |
| On ≥41% of the dairy farms | 2 (5%) | 1 (3.6%) | 1 (8.3%) | NS | 2 (6.7%) | 0 (0%) | NS | 0 (0%) | 2 (9%) | NS |
Abbreviations: BVP, bovine veterinary practitioners; NS, non‐significant.
Less than or equal to 50 years of age.
More than 50 years of age.
p‐values ≤0.05: significant; p‐values = 0.05–0.1: indicative for a tendency.
Less than or equal to 10 years of experience in practice.
More than 10 years of experience in practice.
Synulox (Zoetis): amoxicillin, clavulanic acid and prednisolone or Mastiplan (Intervet): cephapirin and prednisolone.
Ubrolexin (Boehringer Ingelheim): kanamycin and cefalexin or MASTI‐kel (Kela): procain benzylpenicillin and neomycin.
An off‐label cow‐side self‐made mixture of antimicrobials and other drugs.
Twenty‐six (65%) of the participants reported taking milk samples for BC of subclinical mastitis cases from less than 20% of the farms in their clientele, while only two (5%) conducted such sampling on more than 40% of the farms (Table 5).
DISCUSSION
This study aimed to fill in the knowledge gap concerning the practices and opinions of Flemish veterinarians on udder health‐related AMC and UHMS. Notably, this was the first study of its kind in Flanders, despite the critical role veterinarians play in addressing AMR and AMC. The gained insights are valuable not only for policymakers and universities training future veterinarians but also for the BVP themselves, offering a reflection on their own practices and beliefs. Overall, the results demonstrate that there is considerable room for improvement in the frequency of providing and the content of herd health management services in broad terms. Also, we revealed that mainly younger and early‐career BVP tended to be more aware of AMC, AMR and the importance of UHMS.
Throughout the analysis, a distinction was made between young, old, early‐career and mid/late‐career veterinarians. This was opted for as the frequency of prescribing/dispensing antibiotics has been linked to the prescriber's age and his/her time in practice before in human and veterinary medicine. 13 , 14 , 15 Our results support this trend, showing that younger and early‐career BVP were more likely to follow the AMCRA guidelines and use fewer fourth‐generation cephalosporins, use more NSAIDs, engage more in UHMS and were more conscious of the rising problem of AMR and the dairy sector's contribution to AMR than older and mid/late‐career BVP. This finding is logical because most early‐career (<10 years of experience) BVP are also younger than 50 years of age due to the graduation age being approximately 25 years in Belgium. The generational difference between younger and early‐career versus older and mid/late‐career BVP could be attributed to the increased emphasis on pain relief (use of NSAID), AMR and prudent AMU that is now advocated more during university training than it used to be in the past. Additionally, younger and early‐career BVP might be more motivated to apply best practices, given their longer career horizon compared to older and mid/late‐career BVP, the latter potentially facing fewer long‐term professional consequences of excessive/less judicious AMC. Next to the distinction between age and years in practice, sex differences were also explored. Male respondents tended to be more involved in some UHMS aspects and indicated making more use of critically important antibiotics such as fourth‐generation cephalosporines than female respondents, while female respondents were more convinced of the importance of AMC in relation to AMR. The finding that female veterinarians are more conscientious than their male colleagues may explain the results of our study to some extent. 16
A majority of the BVP indicated adherence to guidelines outlined by AMCRA regarding mastitis treatments, avoiding the use of critically important antibiotics such as fluoroquinolones and fourth‐generation cephalosporins, unless really necessary. However, a substantial proportion still made use of, or even dispensed, these compounds, with dairy producers’ influence/pressure as one reason to do so. The pressure of the client to prescribe certain antibiotics has also been reported by others. 15 , 17 , 18 Mostly younger and early‐career BVP claimed to adhere more strictly to the AMCRA guidelines than older and mid/late‐career BVP, although one may suspect that the former are more susceptible to client pressure, especially early in their careers. The fact that the AMCRA guidelines have been published starting in 2012 may explain why the latter are less familiar with them. Also, the knowledge of the BVP regarding pharmacology can be discussed, as some of them made use of aminoglycosides and sulfonamide‐trimethoprim for the treatment of subclinical mastitis. As these active ingredients poorly penetrate the udder tissue, systemic usage in cases of subclinical mastitis is not best practice. Additionally, macrolides—a second choice, orange product according to the AMCRA guidelines and a critical antibiotic according to the WHO—are also often used to treat subclinical mastitis. This raises the question whether BVP are truly mindful of the active ingredient present in the products they administer and dispense and whether these active ingredients are effective against the disease they intend to treat.
Despite 38 of all BVP (95.2%) agreeing with the statement that the advisory role of the veterinarian is important, only few of the BVP, and more younger than older BVP, actually provide (to a small extent) UHMS, with 13 abstaining from it. The discrepancy between the perceived importance and the actual implementation of UHMS highlights the gap between opinions and daily practices. This suggests that acknowledging their value as udder health advisor does not automatically mean that BVP actually (can) implement this service in their daily routine. Not providing UHMS on dairy farms does not imply no other management services are provided. Farmers and BVP may prioritize services such as fertility management, nutrition, young stock management, dry period management, and claw health, which are of greater interest or specialization to them. Some BVP may focus exclusively on these areas, delegating, for example, UHMS responsibilities to other colleagues, but only when this is what the dairy producer wants. Additionally, another reason for not providing UHMS could be that BVP administer medication without conducting a diagnosis. The respondents mentioned time constraints and their perceived need for more resources and better training as challenges to overcome to enhance their advisory capabilities. What is also concerning is that of the 27 BVP that provided UHMS, 12 did not consistently charge for their advisory services, undervaluing their expertise, knowledge and scarce time. This is a missed opportunity, knowing that the majority of Flemish dairy producers actually see high value in the advisory role of the veterinarian concerning UHMS on‐farm.
The growing concern towards AMR will eventually force veterinarians to change their business model to include proactive services that focus more on prevention than on therapy. Next to preventive measures, alternative treatment strategies such as selective dry cow treatment and selective treatment of non‐severe clinical mastitis are also important to decrease AMC on‐farm. 19 , 20 Hence, educating and informing farmers about such alternatives and offering support, for example, in the form of rapid on‐veterinary‐practice testing as part of an evolving business model, are essential. 6 Although most of the BVP acknowledged the importance of BC regarding clinical mastitis treatment, only a few of them had already established an in‐practice milk laboratory. Only a minority actually consistently takes milk samples for BC, while half of them are treating some cases of clinical mastitis without antibiotics. This means that a majority is treating (selectively) in an empirical manner, rather than evidence‐based. This underutilization of BC of milk underscores a gap in practices that could optimise treatment outcomes and reduce AMC substantially, and could push veterinary UHMS forward. Some possible barriers for routine sampling for BC could be the time delay until the result when samples are sent to the regional laboratory (up to 5 days), the lack of interest from the dairy producer and the lack of knowledge and time to perform BC at the veterinary practice.
It is encouraging that most of the BVP (and more young than older BVP) accept that the dairy sector has to decrease AMC (and AMR) and that they play a crucial role in this process. Nonetheless, their actions do not seem to align with this opinion (e.g., milk sampling routine frequency vs. perceived importance of BC, antibiotic use vs. AMCRA guidelines and low grade of discussing benchmark reports), which is alarming. According to the transtheoretical model of change and the theory of planned behaviour, awareness of a behavioural problem and the intention to change this behaviour are necessary for change. 21 , 22 Once the intention to change is present, external influences may help to facilitate the actual behaviour. Among the responding BVP, the intention to change treatment behaviour and to work towards preventive herd health management was present, which is hopeful. Additionally, some external influences such as tools (e.g., rapid tests, specific laboratory software for the collection, storage and analysis of BC results), training and education, and regulations (e.g., European Regulation 2019/6) are available or in place. Unfortunately, a high percentage of the participating BVP mentioned external factors such as time constraints and lack of interest of the dairy producer as inhibitory factors. This suggests a need for policymakers to invest more in raising awareness among dairy farmers about AMR and changing legislation, as well as providing time‐management and communication training for veterinarians.
Prudency is required in extrapolating the findings of this study towards the whole BVP population, as we only received detailed input from 40 veterinarians, with no females in the old and mid/late career category. The absence of female BVP in the older age category, alongside an increased representation among younger practitioners, reflects a demographic shift within the veterinary profession. This trend is not unique to Belgium but is also observed across other European countries, indicating a broader generational and gender‐related transformation within the field. 23 The limited participation in general may be due to a lack of interest in the subject, ‘questionnaire‐fatigue’, unwillingness to participate in any study, poor timing of publication, low visibility of the announcements, but also because of time constraints. The latter suggests that BVP are caught in a vicious circle of not having time to invest in UHMS, nor in training, nor in expressing their views or raising their voices. Making time to complete questionnaires and participate in discussions is, however, essential to inform veterinary colleagues, universities, veterinary organisations, and decision makers to make change happen. Another limitation to take into consideration is a response bias, as people tend to give ‘favourable’ answers. This could be the case in the questions regarding the AMCRA guidelines, for example, and may not be a true reflection of the practices in reality.
CONCLUSION
This study highlights important gaps in the practices and opinions of Flemish dairy cattle veterinarians regarding (udder) health management, antimicrobial usage and AMR. Despite recognising the importance of their advisory role in herd health management, many veterinarians underutilise BC, do not (or in little extent) participate in (U)HMS and do not consistently charge for their services, indicating an undervaluation of their expertise. There is a disconnection between veterinarians’ beliefs about the importance of the reduction of AMC and AMR and their actual practices, with younger/early‐career veterinarians showing more adherence to guidelines and awareness of problems than older and mid/late‐career veterinarians. A need for ongoing education and support to enhance veterinarians’ capabilities and motivation in delivering effective and consistent (U)HMS and antimicrobial stewardship is certainly needed. Addressing barriers such as time constraints and dairy farmers’ understanding of udder health topics may be of importance to improve the quality of care provided to their clients and to promote more evidence‐based, preventive approaches in dairy farming.
AUTHOR CONTRIBUTIONS
Lien Creytens designed the questionnaire, collected and analysed the data and wrote the manuscript. Sofie Piepers and Sarne De Vliegher designed the study and revised the questionnaire, the data analysis and the manuscript.
CONFLICT OF INTEREST STATEMENT
The authors declare they have no conflicts of interest.
ETHICAL STATEMENT
This study was conducted in accordance with the General Ethical Protocol of the Faculty of Psychology and Educational Sciences at Ghent University. The research involved asking participants questions in a fully anonymous manner, without collecting or processing any personal data. No sensitive information was gathered, and no vulnerable populations were included. As such, no specific ethical approval was required.
ACKNOWLEDGEMENTS
This study is part of a VLAIO (Flemish Agency for Innovation and Entrepreneurship)‐sponsored project (HBC.2020.3192). The authors acknowledge the projects’ partners Hooibeekhoeve, ILVO (Flemish Scientific Institute for Multidisciplinary Research in the Agricultural sector, Fisheries and Food sector) and DGZ Vlaanderen vzw (Flemish Animal Health Service) and the bovine veterinary practitioners who completed the questionnaire.
Creytens L, Piepers S, De Vliegher S. Belgian bovine veterinarians' practices and opinions on udder health‐related antimicrobial use and services. Vet Rec. 2025;e1–e16. 10.1002/vetr.6029
The authors acknowledge the projects’ partners Hooibeekhoeve, ILVO (Flemish Scientific Institute for Multidisciplinary Research in the Agricultural sector, Fisheries and Food sector) and DGZ Vlaanderen vzw (Flemish Animal Health Service) and the bovine veterinary practitioners who completed the questionnaire.
DATA AVAILABILITY STATEMENT
Data are available up on reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are available up on reasonable request.